Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some pretty amazing people. You’ll be hearing about what health literacy is, why it matters and most importantly, how we can all help improve health understanding.

Today, I’m talking by phone with two people from two very different professions located in two different locations. But as you will soon hear, we have a remarkable amount in common when it comes to communicating clearly about health.

Heather Schragg is Director of Patient Experience at Eaton Rapids Medical Center in Eaton Rapids, Michigan. She not only oversees the hospital’s risk and quality management programs, but also its initiative to improve patient and employee experiences.

I met Heather when interviewing her on stage about why health literacy matters. It was clear to me then and has been ever since that Heather is committed to helping patients navigate and understand the complicated healthcare system.

Mitch Ross is a police officer in Milwaukee, Wisconsin. Over the years, he’s held many positions, including work in an anti-gang unit squad and on a major incident response team. He also is an adjunct professor at the Milwaukee Police Training Academy.

In addition, Mitch educates civilians about reporting suspicious activities and responding appropriately during active shooter events.

Mitch and I met at a conference for risk managers. He listened to my presentation and I listened to his, and then we realized that our fields face many of the same communications challenges.

Welcome to you both.

Mitch Ross: Thank you. Thank you for having us.

Helen Osborne: Law enforcement, hospital administration, health literacy. From your perspectives, what in the world do we have in common when it comes to health communication?

Mitch Ross: I think what we have in common is that, in the law enforcement side, communication with the citizens is so important. On many days, law enforcement finds themselves with these people in the hospital setting and gathering the information is extremely important.

Helen Osborne: You talked about citizens. That’s the term that police use for the lay public, correct?

Mitch Ross: Correct.

Helen Osborne: You said communicating with citizens is important. That would be the equivalent in healthcare of communication with the public and our patients, right? What are some of the problems in doing that?

Mitch Ross: I think if we look at the recent years, the last three years or so, encounters that we’ve had with citizens or the general public that normally would be maybe local news turns into spotlight situations, and the next thing you know, it’s national news.

Mostly, I’m talking about the recent shootings over the last three years or so. Then you bring social media into it and it just explodes.

Helen Osborne: Yes, it’s horrific what’s going on. I can’t even imagine what it’s like for you, being in the middle of this, and thank you for that. You’re talking about extremely stressful situations it sounds like. Someone is doing something horrid and people are being injured or scared all over the place.

Is that a crisis communication that you’re talking about that’s so hard to communicate?

Mitch Ross: Correct. It’s a situation, and in some cases, they don’t even start out in a crisis. They start out very calm and they turn into a crisis. Much of that has to do with what I would call nonverbal communication, just by us driving up. The communication has already started just by the squad car pulling up.

Helen Osborne: Thanks for that, Mitch. Heather, put this into the hospital/healthcare world. Mitch talked about going from calm to a crisis — what we look like, how we near the situation, how that can escalate. Is that equivalent?

Heather Schragg: Absolutely. On the healthcare side of life, our communication is key and bringing in health literacy is very important.

On the medical side of life, we have a lot of medical jargon. We have big words, medical words, and medical terminology that often the patient or community members do not know, don’t understand and are not familiar with.

Helen Osborne: Give an example, please.

Heather Schragg: For instance, acute myocardial infarction or an AMI, we can say as a heart attack. A heart attack is something that a common person from the community is familiar with.

If you go in and say “acute myocardial infarction,” or the acronym, AMI, most people are not going to understand that. If you go in and say, “We think you’re having a heart attack,” most people are going to understand that.

It’s very important that, when we are interacting with our patients, we’re using common language.

If we’re speaking about medication, we’re not going in and saying, “We’re going to give you a dose of hydrocodone or hydromorphone.” We’re going in and we’re giving them the common names that they’re used to. “We’re going to give you a dose of Norco.” These are the names that people are most familiar with.

Helen Osborne: If I or my loved one or whoever I’m going to the emergency room with might be having a heart attack at that moment, yikes, that went from a calm day to all of a sudden a stressful one. You’re throwing in other language, other words, other terms, and you’re rapidly communicating that with me.

That is an emergency situation, correct? I assume there’s an equivalent in the public, a shooter or something awful going on in a police way, correct?

Mitch Ross: Correct. I think when we handshake law enforcement with the medical field, positioning is so important. When we’re just in the room, whether it’s in the ER or in the doctor’s office, where we sit and how we speak to the patient and maybe even family members that are there is so important.

In law enforcement, in order to gain the compliancy and maybe also bring a calmness to a situation and get the information that we need, there’s a term we use called mirroring.

Helen Osborne: What’s that?

Mitch Ross: Mirroring is if you were looking in a mirror. We want to mirror that person. We watch the body language. If they touch their face, maybe we want to touch our face. Then there’s also reverse mirroring. What that does is it builds a rapport with the person.

If you can imagine interviewing in an interview room, let’s say we’re interviewing a homicide suspect. Obviously, there can be a lot of situations there that they’re not going to want to talk to us after we read rights and all those things. But if we can build this relationship, build an understanding, it’s built through what we call mirroring.

Helen Osborne: That’s really interesting and that seems the flip. We started off talking about situations that go from calm to crisis. Now you’re talking about ways or strategies to go from crisis and bring back some calmness. Is there an equivalent in healthcare, Heather?

Heather Schragg: Absolutely. We have techniques that we also use. We have a thing that we use here at our facility call a Patient Communication Standard. It’s all how we talk to a patient.

Clearly, when a patient comes to a healthcare facility, they’re often not feeling well. They’re sick or stressed. They’re here because they need help. They need to get well. Often, maybe they’re panicked or very scared, so the way we talk to them is key.

When we enter the room, we explain to them our name, our position, what they’re there for and what we’re going to be doing. If they’re going to be having testing done, it’s what to expect in the test and how long to expect that it is going to happen.

If they’re going to be seeing someone else from another department, then let them know, “Maybe you’re going to be seeing somebody from radiology or laboratory. This is what you can expect to be happening. This is about how long it’s going to take. They’re a great provider. They’re going to take great care of you,” to try to bring that anxiety down.

Because we’re a small facility, we don’t have security, so if somebody is getting quite agitated or disgruntled, we may need to call in law enforcement for backup.

Helen Osborne: That’s really interesting. You’re talking about doing all those things. Mitch talked about mirroring and the nonverbal language. Heather, you’re talking about saying your name, calmly saying what to expect, next steps and doing those handoffs.

It sounds like you both are trying to reduce that level of crisis, reduce that level of anxiety no matter what had just precipitated this, correct?

Mitch Ross: Correct.

Heather Schragg: And building trust.

Helen Osborne: Sometimes our worlds overlap, so sometimes healthcare and police and law enforcement come together at the same time in the same ways. I’d love to hear stories from each of you about an example of how those worlds sometimes really intersect.

Heather, keep going. You were talking about sometimes you have to call in law enforcement.

Heather Schragg: Yes. Sometimes, when we have disgruntled patients, we may need to call in our local law enforcement. They are very supportive of our hospital. We may need it just for the presence, just so that the patients know that they’re there.

Patients often become very compliant when police officers are around. They may not need to actually interact with the patient and the patients will become very compliant to our physicians and our staff.

Sometimes we’ll have patients become verbally aggressive, name-calling or whatnot, slamming doors or different things, but often if it elevates to the next level, if we need to, for instance, use restraints on a patient, we may need to definitely call in law enforcement.

That’s where they become very helpful in maybe helping to restrain a patient. If we have, for instance, female staff or a female physician, we might need that extra assistance.

Helen Osborne: Law enforcement actually becomes part of the healthcare team for that period of time.

Heather Schragg: Absolutely, more so working in the background and following our lead.

Helen Osborne: You’re taking the lead and they’re helping you, but you may not know that specific law-enforcement person who’s helping at that moment.

Heather Schragg: Generally, we know them because we are a small community.

Helen Osborne: Thanks. That gives me a good picture of how you might work together within a hospital situation.

Mitch, any stories about how your work and hospital work or healthcare work intersect?

Mitch Ross: I agree with Heather. Even in the larger communities . . . Let’s take Milwaukee, for example. We have seven different districts and several different hospitals, but usually the districts end up going to the same one or two hospitals, so the relationship is already built with that staff 24/7 no matter what time we come in.

I think depending upon why we’re there. Are we bringing in a subject that’s under arrest and maybe was just fighting with somebody or fighting with law enforcement and we have to get them medically cleared?

In many cases, for lack of a better term, they’re already upset with what’s going on and they’ve been dealing with several law-enforcement personnel. They bring that into the hospital setting right off the bat.

Helen Osborne: In the first example, Heather said it’s a patient her team is working with and they bring in law enforcement because they need that extra help at that moment.

In Mitch’s example, the police are working with somebody, maybe under arrest or injured or something and now you need the hospital. Police are taking the lead in that. Is that correct? Then the hospital is your helper?

Mitch Ross: In many cases, again, depending upon the relationship, the police are taking the lead in that room.

Some of the things I like to say to these people to bring this to a calmness, no matter how upset or what the outcome is going to be of that day for them, is we’re in the hospital now and the people that are there are there to truly help them to get better.

“You can be as angry as you want at this uniform that I’m wearing, but we need to let the staff here do what they have to do.”

Does it work all the time? Not all the time. Obviously, Heather has probably seen it where it just doesn’t work and we have to really go hands-on while the person is being worked on.

Helen Osborne: Wow.

Mitch Ross: We’re not doctors or surgeons here, but have a very basic understanding of what some of the processes are that are going to be happening, where we may even have to help out.

The setting may be on the street or in a med unit, where I may have to jump in and start bagging a person so that the medical staff that’s on board can do other things.

Helen Osborne: These stories make it so vivid to me. I was so impressed when I met each of you individually, and then the three of us started this conversation. It was that aha moment, I think, for each of us, as I understood, “Wow, our worlds really are connected.”

As I’m taking notes and thinking about our podcast conversation right now, we started talking about communicating in a crisis. Whether it escalates to a crisis or it starts as a crisis, everybody wants to get back to that sense of calmness.

You both also talked about developing a relationship as much as possible, a relationship with that patient, that person you’ve just arrested or that casualty in there, and developing a relationship.

I’m also hearing the concept of teamwork, teamwork with other professionals who are in this too. Who’s taking the lead? Where is it happening?

What I’m hearing the most is that in all our work, we all want to help. We have that shared goal of making things better and the best possible outcomes you can have in there.

Our listeners are probably not law enforcement and maybe not risk managers, but we care about health literacy and we care about health communication.

Whether we work in hospitals, public health, libraries or school settings, we somehow want to communicate about health more clearly. What would be your takeaway tip to our listeners?

Mitch Ross: There are a couple of things. On the law enforcement side, the more understanding we have when we’re in these settings, in the medical setting, the better. What I mean by that is we haven’t even brought into the subject the understanding of HIPAA.

Helen Osborne: That’s the privacy and protection act. Not all our listeners are US-based. That’s what we have to maintain, privacy and protection. Yes, we all are under that mandate in the US.

Mitch Ross: We need to have that understanding because a lot of times, we’re coming in and we need information, and it may even be medical information. It has to go in reports so that there’s a better understanding of what took place and how this person became this way.

Gathering that information is extremely hard to stay within the laws and the boundaries of not only the hospital, but the hospital personnel.

Helen Osborne: The hospital personnel also would need to know how much they can and cannot share with you at that moment. We all have to work within the bounds of what is legal to do at that moment.

Mitch Ross: We all want to control this situation, A-type personalities. As a law enforcement officer, we need to know when it’s not working and our partners need to know that too, the other officers that show up.

Maybe I have to step out of the setting. Maybe dealing with a female in the ER is not as comfortable as if a female officer was dealing with that person. Those are just the basics.

Helen Osborne: If I can recap those, it seems like you need to know what the limits are, the boundaries too.

Mitch Ross: Correct.

Helen Osborne: Whether it’s legal boundaries or your personal boundaries, get a sense of that as well. We can’t be everything to everybody all the time. Thanks, Mitch.

What about you, Heather? Any takeaway tips for our listeners?

Heather Schragg: I think some of the biggest takeaways for me in this role are to remember that everyone has a story. No matter how a patient is acting, especially if they’re acting agitated, disgruntled, fearful, scared or they’re acting out, they have a story. It’s our job to get to the bottom of that and to communicate clearly.

I try to always remember to act like the person on the other side, to try to remember that they are somebody’s family. They are not just somebody there trying to give you a hard time. They are there with a reason. They’re there for a purpose. They need us to help them.

They have a story, and it’s our job to treat them with compassion and kindness and to really communicate very clearly and in a common person’s terms so that they understand what is happening to them. I think that if we do that with every patient, every time, we’re doing our job.

Helen Osborne: Thank you. Thank you both so much. Boy, those strings just come through. Thank you both for sharing your stories and your experiences and with compassion, kindness and commitment. Communicating clearly comes through whatever we do. Thank you for what you do and for sharing it with us on Health Literacy Out Loud.

Heather Schragg: Thank you, Helen.

Mitch Ross: You’re very welcome. Thanks for having us.

Helen Osborne: Wow. I’ve learned yet again so much about clear health communication. This time it was from Heather Schragg and Mitch Ross, speaking about it from the perspective of risk management in hospital and law enforcement.

I hope you learned a lot too, but communicating clearly and simply and considering health literacy is not always easy. For help communicating your health message that way, please contact me or visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you are there, feel free to sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

New Health Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes as well as the Health Literacy Out Loud website, www.HealthLiteracyOutLoud.com.

Did you like this podcast? Even more, did you learn something new? I sure hope so. If you did, tell your colleagues and tell your friends. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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